The federal agency that oversees the joint federal-state Medicaid program said Tuesday that states must obtain federal approval before making changes to their state’s Medicaid program.

On Friday, McMaster booted Planned Parenthood from the state’s Medicaid network, terminating its ability to seek tax dollars to pay for providing health care services — for example, testing for sexually transmitted diseases — to the state’s poorest men and women.

However, health care advocates say McMaster’s order violates federal Medicaid laws since Planned Parenthood performs health care services and not just abortions. Federal law already bans abortion providers from using tax dollars for abortions, except in cases of rape, incest or when the mother’s life is endangered.

In the past two years, Planned Parenthood has received less than $85,000 in Medicaid reimbursements — a fraction of family planning dollars that state lawmakers budget.

Last August, McMaster asked the federal government for a waiver to permit the state to exclude abortion providers from the state’s Medicaid network. But that waiver request has not been received or approved by the federal government, the Centers for Medicare and Medicaid Services said Tuesday, adding states must seek the agency’s approval for changes to their Medicaid programs.

The state’s Health and Human Services Department said it submitted the request but has been asked to edit it and send it again.

Planned Parenthood has declined to say whether it will sue but says it will still serve S.C. Medicaid recipients despite the order.

“Planned Parenthood is committed to keeping our doors open for anyone who needs access to basic, affordable health care,” said Sarah Riddle, spokeswoman for Planned Parenthood South Atlantic.

On Friday, the governor’s spokesman Brian Symmes said McMaster is willing to take on a lawsuit.

“The governor has been very clear ... that he firmly believes no taxpayer dollars should directly or indirectly subsidize abortion and this is another step in that direction,” Symmes said.

McMaster’s critics have called the governor’s actions a stunt, saying he is only trying to score points with the state’s conservative and evangelical voters before his November general election contest against state Rep. James Smith, a Columbia Democrat.

On Friday, Smith said unlike McMaster, he would “never play political games” with South Carolinians’ health care.

Who gets family planning money?

This month, Gov. Henry McMaster vetoed nearly $16 million in family planning money in the state’s budget in an effort to defund Planned Parenthood. But almost all of that money went to other health care providers. Here were the top five recipients in 2017: